Section He-W 508.07 - Recipient Notification of Cost Effectiveness Monitoring and Determination Results(a) When the department's monthly monitoring of cost effectiveness results in an estimated, projected annual home care cost for a recipient which is higher than the appropriate type of institutional care cost, the department shall notify the recipient in writing.(b) The notification in (a) above shall include:(1) A reminder of the requirement to maintain annual home care costs at or below the cost of care for the appropriate type of institution pursuant to state and federal law in order to maintain HC-CSD eligibility;(2) Medicaid payment data showing the recipient's monitored home care costs and estimated, projected annual home care costs, including a copy of the report used;(3) The calculated cost of care in an appropriate type of institution for the same time period as in (2) above and the projected annual institutional costs, including identification of the appropriate type of institution; and(4) Contact information for the department's care coordination services unit.(c) Upon receipt of the notification in (a) above, the recipient's family or guardian may contact the department: (1) For an explanation of the information included in the notification pursuant to (b) above;(2) To report costs they believe the department should not include in the home care costs; and(3) To request assistance with reducing the costs of home care or achieving cost effectiveness pursuant to He-W 508.06(a) .(d) For each state fiscal year ending June 30, the department shall complete an annual determination of cost effectiveness for each recipient pursuant to He-W 508.06(b) .(e) If the department's annual determination of cost effectiveness indicates that home care costs are higher than the costs of the appropriate type of institutional care, the department shall provide written notice to the recipient within 30 days of the determination.(f) The written notice pursuant to (e) above shall include:(1) A statement that annual cost effectiveness has not been demonstrated;(2) A statement that the recipient is required to reduce and maintain annual home care costs at or below the cost of care for the appropriate type of institution pursuant to state and federal law in order to maintain HC-CSD eligibility;(3) Medicaid payment data showing the recipient's annual home care costs and a copy of the report used;(4) The calculated annual cost of care in an appropriate type of institution, including identification of the appropriate type of institution;(5) A statement that the recipient's family or guardian shall submit and implement a written plan for reducing costs in accordance with (f) (2) within 3 months of the date of the notice in (e) above;(6) Contact information for the department's care coordination services unit which the recipient's family or guardian may use for assistance in identifying any billing errors and in developing the cost reduction plan in (5) above; and(7) Information that a fair hearing on the requirement to reduce costs may be requested within 30 calendar days of the date on the cost effectiveness annual determination notice, in accordance with He-C 200.(g) If the recipient's family or guardian requests assistance in accordance with (f) (6) above, the department shall assign a care coordination manager to assist the recipient's family or guardian.N.H. Admin. Code § He-W 508.07